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Cause of Meniere's Disease
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Table of Contents

===== An Ambiguous Definition =====

The term "Meniere's Disease" is ambiguous. In one sense, it means that one has the symptoms (either typical or atypical) that are the same for a whole slew of diseases and conditions (including Meniere's Disease), but testing for all diseases and conditions other than Meniere's Disease turns out negative.  (See our diagnosis page.) Since there is no definitive test for Meniere's Disease, the conclusion (by "excluding" all "testable" and tested diseases and conditions) is that the patient must have "Meniere's Disease." In this sense, "Meniere's Disease" means "we don't know what is causing the symptoms."

In another sense, the majority of authoritative sources will conclude that "we don't know" Meniere's Disease is tantamount to (or even equal to) "idiopathic endolymphatic hydrops" (IEH). "Idiopathic" means "cause unknown." Therefore, when Meniere's Disease is taken to mean "idiopathic endolymphatic hydrops," it means that the patient has been diagnosed with "endolymphatic hydrops from unknown causes." A minority of authoritative sources will say, "we don't know what is causing the symptoms, so we will say that the patient has 'Meniere's Disease,' which may or may not be idiopathic endolymphatic hydrops or microvascular compression syndrome or something else."  See the main story in this newsletter (.pdf file), which questions the role of endolymphatic hydrops in Meniere's Disease.

A diagnosis of Meniere's Disease or "idiopathic endolymphatic hydrops" means that, by definition ("idiopathic"), no one knows the cause. Such a diagnosis makes the issue of causation problematic, whether it be in connection with an automobile accident or other head injury, or in connection with military service, or in connection with employment.  In other words, under this scenario, when one has Meniere's Disease, one cannot say it was "caused" by anything.

If one is diagnosed with endolymphatic hydrops that results from some known cause, such as head trauma or some other cause, then one would have simply "endolymphatic hydrops" (EH) or "traumatic endolymphatic hydrops" (TEH) or "secondary endolymphatic hydrops" (SEH) (where endolymphatic hydrops is "secondary" to the trauma or some other cause) or, if there is a delay in the onset of endolymphatic hydrops resulting from the trauma or some other cause, "delayed endolymphatic hydrops" (DEH). (See our diagnosis page.)  All this can be confusing, especially because a few authorities use the term "post-traumatic Meniere's Disease," which we find paradoxical.  Click here to search PubMed for post-traumatic and Meniere's or endolymphatic hydrops.

But sometimes doctors are just imprecise with their terminology, or doctors' employees are just imprecise with encoding insurance claim forms, and endolymphatic hydrops that results from some known cause, such as head trauma or some other case, is erroneously described as "Meniere's Disease."

While these distinctions may make little difference to some, or may be of no interest to others, they are of major importance when causation is of legal consequence in terms of damages or benefits. In such cases, it becomes particularly important to have a doctor who specializes in or otherwise has a great deal of experience in diagnosing and treating all forms of endolymphatic hydrops, Meniere's Disease and otherwise, and knows the differences between them.  And, as always, we recommend multiple medical opinions.  (See our doctors page.)
 

  • Cause (etiology). 
    • Meniere's Disease is "idiopathic" -- the etiology (cause) of the condition that gives rise to Meniere's Disease symptoms is unknown, although there is a great deal of research under way.
    • "Unknown" as in "unknown."
      • As in *really, really* unknown.
  • Nature of the condition. 
    • There is disagreement over the nature of the condition that gives rise to Meniere's Disease symptoms.
    • Some researchers believe that Meniere's Disease is one thing and one thing only:  idiopathic endolymphatic hydrops.  Other authorities believe that *some* cases of Meniere's Disease are idiopathic endolymphatic hydrops and that *other* cases have other etiologies (causes).
    • Idiopathic endolymphatic hydrops (IEH).
      • According to the prevailing, but not definitive, theory, Meniere's Disease is "idiopathic endolymphatic hydrops."
      • "Idiopathic" means that the cause is unknown.
        • If the cause of your symptoms is known, your condition cannot be "idiopathic endolymphatic hydrops," by definition.  If Meniere's Disease is the same as "idiopathic endolymphatic hydrops," and the cause of your symptoms is known, then you cannot have Meniere's Disease, by definition.
      • "Endolymphatic" refers to endolymph, one of two fluids in the cochlea in the inner ear.  (The other fluid is perilymph.)
      • "Hydrops" means excessive fluid build-up (dilatation).  Think:  swelling.
      • "Idiopathic endolymphatic hydrops" means the "cause unknown build-up of excessive endolymphatic fluid in the cochlea located in the inner ear."
      • See the main story in this newsletter (.pdf) from an agency within the National Institutes of Health, in which an article questions the role of endolymphatic hydrops in Meniere's Disease.
    • Endolymphatic hydrops (EH).  
      • The term "endolymphatic hydrops" (EH) encompasses both the "idiopathic" (cause unknown) form, which most, but not all, authorities consider to be Meniere's Disease, and the several non-idiopathic forms, in which the cause is known.
      • Idiopathic endolymphatic hydrops (IEH). 
        • This is Meniere's Disease, according to most, but not all, authorities.  See above.
      • Non-idiopathic endolymphatic hydrops.  There are several forms of endolymphatic hydrops that are not idiopathic because the cause is known and, since the cause is known, these forms of non-idiopathic endolymphatic hydrops are *not* Meniere's Disease.
        • "Secondary endolymphatic hydrops" (SEH).
        • "Delayed endolymphatic hydrops" (DEH).
        • "Traumatic endolymphatic hydrops" (TEH)."
          • According to this article, TEH is "an accumulation of endolymph in the cochlear duct caused by traumatic insult.  According to the article, "The diagnosis of traumatic endolymphatic hydrops is made by a history of trauma, such as barotrauma, a blow to the head, or perhaps a previous ear operation, such as stapedectomy; the presence of typical symptoms of endolymphatic hydrops, including fullness, tinnitus, fluctuant hearing loss, and episodic vertigo; and an elevated negative summating potential and an increased summating potential:action potential ratio by electrocochleography."
        • Click here to search PubMed for traumatic endolymphatic hydrops.
      • Practical attribution.
        • In the absence of observable physical damage, or an obvious explanation in one's medical history, one's endolymphatic hydrops is likely to be attributed to Meniere's Disease, meaning idiopathic endolymphatic hydrops.
    • Microvascular compression syndrome (MCS) (also called "vascular compression" and "neurovascular compression)." 
    • Symptoms can be induced or exacerbated by "triggers." 
      • Many patients can identify "triggers" that induce or exacerbate their symptoms.  "Triggers" are not causes.  To the extent that patients can identify and avoid or treat triggers, they can reduce, but not eliminate, their discomfort from symptoms.  Some patients cannot identify any triggers.
      • See further coverage in the "triggers" section on our Treatment Page.
    • Meniere's Disease is not hereditary. 
    • Herpes simplex virus (HSV).
      • "Herpes" is a family of viruses.  Herpes simplex virus (HSV) is the virus that causes "oral herpes (cold sores)" and "genital herpes."  There are two types, Type 1 and Type 2.  Either type can cause infections in either location, but so far most oral herpes are caused by Type 1 and most genital herpes are caused by Type 2.  Both types are contagious and can be transmitted to either location.
        • A different type of herpes virus, herpes zoster (also called varicella zoster), causes chicken pox and "shingles."
        • Yet another herpes virus, the Epstein-Barr virus, causes infectious mononucleosis ("kissing disease").
      • A very few studies have found a vaguely possible link between HSV and Meniere's Disease, but these studies merely conclude that yet more study is needed.  HSV has NOT been established as "the cause" or even "a cause" of Meniere's Disease.  According to the U.S. National Institutes of Health, 90% of American adults have antibodies for  HSV type 1, and 30% of American adults have antibodies for HSV type 2, but only a tiny percentage of either group develop Meniere's Disease.  There are people who have no antibodies to HSV but who have developed Meniere's Disease.  No study in PubMed states for a fact that HSV is a cause of Meniere's Disease.
        • Nonetheless, we are hearing anecdotal reports from patients that a few doctors are offering antiviral drugs that are usually used to treat herpes simplex virus (and other viruses) to treat some Meniere's Disease.  Read more in the antiviral drug section of our Treatment Page
      • Archives of Otolaryngology/Head and Neck Surgery. Herpes Simplex Virus Antibodies in the Perilymph of Patients With Meniere's Disease.
      • Archives of Otolaryngology/Head and Neck Surgery. Patients With Meniere's Disease Possess IgE Reacting With Herpes Family Viruses.
      • Click here to search PubMed for Meniere's Disease and herpes.
    • Autoimmune etiology (cause).
    • Meniere's Disease is not contagious in any way.
    • Post hoc ergo propter hoc.
      • Although the cause of Meniere's Disease is unknown, many patients spend considerable time trying to guess at what "gave" them Meniere's Disease.
      • If there were a known cause for one's symptoms, one wouldn't have Meniere's Disease, because Meniere's Disease has no known cause and no known origin.
      • It seems to be the nature of humanity that it seeks "reasons" for everything.  People seek "reasons" for their diseases.  The mysterious nature of Meniere's Disease seems particularly to make people seek "the reason" that they have been so afflicted.  Without a attributed reason for their Meniere's Disease, they lack "closure."  Patients often try to find some event to which they can attribute their Meniere's Disease.  Suspects include:  automobile accidents, military service (even three or more decades earlier), ear infections during youth, travel to foreign countries, prescription or illegal drugs, and more.  The practical reality is that, in the absence of observable physical damage (for example, a crushed skull or a gunshot wound), there is unlikely to be any provable association, and one's endolymphatic hydrops is likely to be dubbed "Meniere's Disease."  While patients may convince themselves of a cause of their Meniere's Disease, the reality is that no one knows the cause of anyone's Meniere's Disease.
      • There is a logical fallacy, post hoc ergo propter hoc (after this, therefore because of this), to which Meniere's Disease patients often fall victim.  That is to say that patients, having settled upon some event that preceded their Meniere's Disease symptoms, become convinced merely because of the timing that the event is the "cause" of their Meniere's Disease.  This is quite understandable, but scientists will likely conclude that while causation is possible (in the sense that alien abductions are possible), there is no proof of causation.  Click here for a Google search on the fallacy of post hoc ergo propter hoc.  The reality is that most of us will never know what caused our endolymphatic hydrops.
  • Discussions:  cause (etiology) of Meniere's Disease.
  • Epidemiology (incidence and prevalence) (frequency) of Meniere's Disease.
  • Anatomy.

Copyright © 1997-2014 Meniere's Disease Information Center.  All rights are reserved.
All copying, including (but not limited to) websites, bulletin boards, forums, and blogs, is prohibited.
Click here for more copyright information.